Potential Impact of Pandemic Influenza on the U.S. Health Insurance Industry Report
Research Projects – Health

Sponsored by the Committee on Life Insurance Research, the Joint Risk Management Section’s Research Team, and the Health Section, Jim Toole of MBA Actuaries evaluates the financial effects of different flu pandemic scenarios on the U.S. health Insurance industry. In addition to the research report, he has developed an accompanying spreadsheet tool for individual health insurers to better understand the associated financial risks of a flu pandemic.

This is the second paper in a two-part series examining the potential impact of pandemic influenza on the insurance industry. The first paper focused on the potential impact of pandemic influenza on the life insurance industry.

I have a copy of the spreadsheet tool, and may be looking at this later.

In Epidemics, Leaders Play a Crucial Role
Lessons in heroism and horror as a famed flu pandemic hits a milestone
By Amanda Foreman

March 8, 2018 11:49 a.m. ET

A century ago this week, an army cook named Albert Gitchell at Fort Riley, Kansas, paid a visit to the camp infirmary, complaining of a severe cold. It’s now thought that he was America’s patient zero in the Spanish Flu pandemic of 1918.

The disease killed more than 40 million people world-wide, including 675,000 Americans. In this case, as in so many others throughout history, the pace of the pandemic’s deadly progress depended on the actions of public officials.

Spain had allowed unrestricted reporting about the flu, so people mistakenly believed it originated there. Other countries, including the U.S., squandered thousands of lives by suppressing news and delaying health measures.

…..
[During the Black Plague] In Italy, Venetian took the practical approach: They didn’t allow ships from infected ports to dock and subjected all travelters to a period of isolation. The term quarantine comes from the Italian quaranta giorni, meaning “40 days”—the official length of time until the Venetians granted foreign ships the right of entry.

So I am very prepared to see nothing in the U.S. papers during 1918 with respect to the Spanish flu epidemic — or at least, not reporting that it is occurring in the U.S. In Spain, sure, they may relay that on.

“The Spanish flu,” Laura Spinney tells us, “infected one in three people on earth, or 500 million human beings. Between the first case recorded on 4 March 1918 and the last sometime in March 1920, it killed 50-100 million, or between 2.5 and 5 per cent of the global population — a range that reflects the uncertainty that still surrounds it. …It was the greatest tidal wave of death since the Black Death, perhaps in the whole of human history.”

Yet when it was over, a kind of stunned silence fell on the survivors. People might talk about the carnage of the First World War and the resulting revolutions, but not about the much greater slaughter they had personally witnessed in their own homes and workplaces. My own grandparents, who had small children in 1918 and ’19, never mentioned the flu pandemic.
…..
Nobody knew anything

Nobody knew anything in 1918. The germ theory of disease, a few decades old, was as controversial then as climate change is now. “Virus” was a medical buzzword for “something we can’t see in a microscope that must be causing this or that disease.”

Even the word “influenza” was a hand-me-down from the Middle Ages, when the diagnosis for many ailments was the “influence” of the stars. The 19th century had seen many outbreaks of a respiratory disease called influenza, including the “Russian flu” of 1890 that had killed a million people. Less fatal flu outbreaks occurred yearly, as they continue to do.

So a wave of flu in the spring of 1918 didn’t stir much alarm though it killed more people and those of a younger age than usual — especially in the armies still locked in trench warfare. So many soldiers fell ill that a major German offensive — intended to knock France and Britain out of the war before the U.S. arrived — failed. Even though French and British soldiers were sick as well, they had the advantage of defence. (The Americans, meanwhile, were dying aboard their troop ships en route to the front.)

Most histories of the Spanish flu focus on events in Europe and the U.S., but Spinney’s scope is world-wide. Here is where her book distinguishes itself — by detailed scrutiny of the response to the pandemic in places like Brazil, China and India. All were baffled by the disease and by its seeming randomness. In the gold mines of South Africa’s Rand district, for example, black miners lived under crowded, unsanitary conditions that encouraged pneumonia. They fell ill with the flu, but most recovered. A week later, the flu hit Kimberley’s diamond mines — and the death rate was 35 times that of the gold miners.

Culture played a crucial role. In Spain, a charismatic bishop in the city of Zamora drew crowds into the churches to offer prayers to St. Rocco, the patron saint of plague, making the spread of flu much easier. The authorities tried to forbid mass gatherings; the bishop said they were interfering in church affairs.

…..
But the flu also promoted politics. After the Russian Revolution and civil war, Lenin brought in the first modern public healthcare system (at least for urban Russians). He asked doctors to make epidemic and famine prevention their top priority because flu and famine had nearly wiped out the Russian working classes.

…..
From this she makes an interesting further case: We remember wars and then gradually forget them, while we forget pandemics and then gradually remember them. So, 72 years after the end of the Second World War, we contend with neo-Nazis while we also begin to sense what a shattering event the 1918-19 influenza pandemic really was.

A century later, we are far better equipped to deal with the next flu pandemic but also more vulnerable to it. The 2009-10 “swine flu” pandemic travelled at the speed of modern air travel; British schoolgirls brought it home from a holiday trip to Mexico. It killed over 200,000, a number too small to earn respect. In B.C., we had more than 1,000 cases and a mere 56 deaths — and promptly forgot them all.

Similarly, we keep being told that the most recent seasonal flu season was the worst in a decade (since the Avian flu), but if you look at the mortality curves, it’s about as bad as the 2014-2015 season. But I don’t remember a lot of people going on about how bad the 2014-2015 season was.

SECONDWEEK OF MARCH 1918

So let me jump over the many ads and columns telling you to buy War Savings Stamps (with the W.S.S. between each item) and Liberty Bonds.

Let’s take a look at two pieces by Otto Kahn.

First, against a wealth tax:

Second, saying it’s a lie that the Great War is a rich man’s war:

Both are actually about taxation, and comparing U.S. tax policy, and proposed policy, against other countries.

Let Us Reason Together (1919)
Taxation: A Letter (1918)
Right Above Race (1918)
Poison Growth of Prussianism (1918)
The Menace of Paternalism (1918)
When the Tide Turned (1918)
Frenzied Liberty (1918)
The Common Cause: Britain’s Part in the Great War (1918)
Some Comments on War Taxation (1918)
The War and Business (1917)
Prussianized Germany. Americans of Foreign Descent and America’s Cause (1917)
Art and the People (1916)

What I do want to comment on is the large number of Germans in the U.S. during WWI, and how often they pop up in columns like these — and I can tell from the listing, that Kahn was definitely not on the Kaiser’s side… and that was probably true of most of the German-Americans. If they had liked the Kaiser, they’d be back in Germany.

In Kahn’s case, he hadn’t come to the U.S. until 1893, but many of the Germans in my area came over after the revolutions of 1848. I think that’s one immigration wave people don’t think about much now, possibly because it’s less stark than the Great Potato Famine in Ireland, and because the early wave was so much smaller than the ones of the late 19th and early 20th century.

Oh, and here’s another excerpt from that second Kahn piece:

See — all sorts of bad tax ideas keep popping up over and over again.

A MODERNWAR

Just thought I’d pick out a couple items that point to the modern-ness of the war.

Here is one about the armed forces in movies:

We got these sorts of propaganda films in WWII, too, of course.

And here’s a traveling kitchen on automobile:

I may have mentioned it before, but the Brewster Standard had a half-page dedicated to stories on cars each week. Most of them include stuff like this:

Lots of car maintenance tips, etc. There’s a reason chauffeur (which was about stoking engines originally) was a serious job — it was more that it was very difficult to get the car running and keep it running. The driving was the easiest part of the job.

Finally, lots of Knights of Columbus drives in the area, and check out the bottom of this:

Of course there were scamsters trying to trick donors. It’s a national pasttime!

That’s all for this week’s look back on 1918 — still no suspicious deaths, but as said above, this was the official start of the Spanish flu in the U.S…. though it wouldn’t be recognized for many months.